AADA joins letter opposing modifier 25, other Anthem payment changes

January 16, 2018

The AADA joined medical specialty societies and patient advocacy groups in sending a letter to Anthem's chief clinical officer to express concerns about controversial changes to Anthem payment policies. The letter urges the insurer to rescind plans to 1) reduce physicians' reimbursement when they bill for E&M services billed with a modifier 25, 2) largely deny advanced imaging performed in the hospital outpatient setting, and 3) deny coverage for services provided to beneficiaries for retroactively determined "non-emergent" health care services in the Emergency Department. The letter states that "Anthem finalized these changes despite mounting evidence that the justification for the policies is flawed and would hinder patients' access to physician care."

Click here to read the letter.